The People's Pharmacy Show 1003: From Lyme to Alpha-Gal: The Latest on Tick-Borne Diseases
The People's Pharmacy aired a show on public radio on lyme disease recently. The diagnosis and management of this illness is currently highly controversial within the medical community. A number of physicians speak on the topic of tick-borne illnesses: various experts and a physician who suffered from lyme disease for several years before being diagnosed. I believe you will find this show fascinating and worth the time it takes to listen to it.
The People's Pharmacy Show 1003: From Lyme to Alpha-Gal: The Latest on Tick-Borne Diseases
If you're not familiar with the the Whole30 program, check it out here: whole30. While you can execute and reap all of the benefits of the program using these few pages alone, why not take advantage of the knowledge, advice, and tips from the authors and others who have successfully completed the program and gone on to radically improve their health? That's where The Whole30: The 30-day Guide to total Health and Food Freedom comes in. Authors Dallas and Melissa Hartwig are back with this comprehensive guide to their Whole30 program. Any question you may have about the program should be answered in this book. The book provides a well-designed guide to conquering the 30-day program leading to your new lifestyle of healthy eating. They cover the rationale behind the program, what to expect when you embark on it, a comprehensive guide to the reintroduction phase, drinks, supplements, dining out, traveling, kids, weight loss, vegetarians/vegans, kitchen needs, and references to approved products. There is also an awesome section on cooking with a ton of recipes, some to impress (see the "fancypants"section) and some quick and easy for everyday use in your busy schedule.
I'll admit that I have a few small parts in there that I contributed. I've also recommended their program to numerous patients in my practice with amazing, and sometimes nearly miraculous results. If you want to know why this program works, pick up a copy of their previous book, It Starts With Food, which goes into the science behind their recommendations. If you haven't tried the Whole30, I'd encourage you to discover its benefits for yourself.
Many people start eating in a more healthful way coinciding with the start of the new year. Perhaps it’s part of a new year’s resolution or recovering from holiday indulgences. While I recommend the Whole30, almost any dietary change that promotes health will have you eating a lot more fruits, vegetables, and whole foods. In fact, if the program you’re following does not, it might be worth reconsidering if improved health is what you’re looking for.
I laud you on your New Year’s resolutions but realistically it is common to fail in spite of the best intentions. To increase the chance of new dietary habits enduring, focus on removing barriers that make it more difficult to sustain new habits. A barrier that comes up frequently in regards to diet is the amount of time spent on food preparation. While it is easier and much less time-consuming to eat processed edible food-like substances from a box or a restaurant, making your own fresh food gives you control over the quality of the ingredients, connects you in a more intimate way to the food you are eating, and allows you to eat in a way to maximize your health and well-being. Most people already have their schedules maxed out with work and/or school, maybe kids, maybe pets, some form of physical activity, and all of the routine challenges of maintaining a successful day-to-day life such as keeping clothes clean, paying bills, and maintaining a modicum of personal hygiene. Throw in social networking, email, and working through a streaming video que and there ain’t no way there’s gonna be enough hours in the day to cook something. The new health-promoting diet that requires daily food preparation may become the proverbial straw.
Well here’s a few ideas to alleviate some of the time pressure for preparing your own delicious and healthy food at home:
These tips can be helpful in decreasing the amount of time it takes to prepare a healthy meal at home. You may wish to employ these tactics only when extremely maxed out on time or more frequently. How often you wish to use them is up to you and perhaps they become the de facto methods utilized in your kitchen. Employ them as you see fit. The more important thing is to consistently eat a reasonably healthy diet.
Ebola, a viral illness transmitted through contact with body fluids of infected individuals, causes a hemorrhagic fever. After an incubation period lasting from a few days for up to 3 weeks, an infected individual develops malaise and fever in addition to nausea, vomiting, and diarrhea. Eventually profuse bleeding occurs, causing its victim to perish. The reported fatality rate is 90%.
Since February, this virus has spread over three countries in western Africa and at the time of this writing has claimed the lives of over 400 people. Currently, a U.S. citizen is being tested for the virus and has been placed in quarantine in Ghana after travelling through two of the affected countries.
For more information: BBC - Ebola Outbreak
This outbreak is not contained and will likely spread before we see it brought under control. To get a sense of what may be at stake here, read The Hot Zone, by Richard Preston. It details an incident that occurred in 1989 where a similar outbreak almost occurred in the U.S.
I urge you to read this brief article highlighting the work and personal experience of Dr. Terry Wahls and the profound implications nutrition can have on disease states:
How to Make Doctors Irrelevant
You may have read in the news in the past several weeks that the FDA has ordered personalized genetic testing company, 23andMe, to halt the sales of it’s $99 home genetic test. The company’s test provided an affordable means of detecting multiple genes that can benefit people in their ongoing medical care and quest for optimal health.
One of the genes it looks at is the MTHFR gene. Thirty percent of caucasians have an alteration of this gene, causing a much higher biologic need for folate than those who do not have the gene alteration. Not meeting the body’s demand for folic acid can have deleterious health effects and can play a role in both depression, heart disease, and development of neural tube defects in unborn children. Testing for alterations in this particular gene can be beneficial in forging a treatment plan to treat or prevent disease. I can order this single gene test through our hospital, at a cost of $175. I can also order it from a different outside lab for substantially cheaper, $48, once again to test for that gene only. In my experience thus far, no insurance company has been willing to cover the cost of testing for this particular gene, leaving patients to cover the cost of this test out of their own pockets.
The service 23andMe provides gives results for multiple other genes as well. Other genes it tests for include a set that codes for enzymes that metabolize drugs. If there are alterations in these genes, you may need more or less of a certain medication to achieve the therapeutic effect. Drugs now are prescribed by standard doses, a “one-size-fits-all” approach. With patients who have genetic variations in these drug metabolism genes, they may not tolerate a particular drug or others may not have a medication work for them at standard doses. Good medicine would test a patient’s genes and dose medications accordingly. This idea is before its time but is currently available to cash-paying patients. I can also have these genes (the same ones included in 23andMe’s test) tested for by a lab company for around $400. Once again, this test is not covered by insurance.
23andMe’s test covers many, many genes beyond those discussed above as examples. It provides therapeutically pertinent information at a much reduced cost for what other companies are offering these same services for. From what I can ascertain from the media coverage of the FDA’s crackdown, the concern they have with 23andMe is their marketing claims and interpretation of test results they provide consumers. To the best of my knowledge, the validity of the test is not being called into question by the FDA. I have been unable to find a copy of the letter the FDA sent to 23andMe and 23andMe’s statement on their blog does not elucidate the nature of the FDA’s claims against them.
While the use of genetics in clinical medicine is still in its infancy, my hope is that these two organizations can resolve their dispute quickly and that the public may continue to purchase potentially useful and life enhancing genetic testing at a low cost and in a manner that is safe and enhances the health and well-being of patients. There are other direct to consumer genetic testing companies out there but 23andMe is the one I am most familiar with. The resolution of the dispute between them and the FDA will set a precedent for direct to consumer genetic testing services in the future.
I ran across this article the other day describing a case worthy of an episode of House. It details the story of a gentleman who got drunk out of the blue without consuming any alcohol at all. He went to the ER one day complaining of feeling dizzy and was found to have a blood alcohol level of 0.37 percent (the legal limit for driving while intoxicated in our state is 0.08.) Suspicious that he was a closet drinker, doctors kept him isolation for 24 hours to ensure he was not sneaking any alcohol and monitored his blood alcohol concentration. It still remained at 0.12 percent long after it should have returned to zero.
An overgrowth of a yeast called saccharomyces cerevisiae within this man’s intestines caused his bizarre condition. Saccharomyces cerevisiae is used in the brewing industry to make alcohol and is commonly known as brewer’s yeast. Doctors treated him with a restricted carbohydrate diet and antifungal medication and his ailment resolved.
The story is an extreme example of a much broader condition called intestinal dysbiosis. While this particular case has its own specific term, auto-brewery syndrome, it is very rare. Intestinal dysbiosis, a more inclusive term, is very common and I see it quite frequently in my practice.
Intestinal dysbiosis is an imbalance in the bacteria in your intestines. Certain species of bacteria belong in your gastrointestinal tract. They have a symbiotic relationship with you. They help you by keeping other, less optimal bacteria out or in check. They also aid in the production of some vitamins and keep your intestinal lining healthy. In turn, you give them a place to live. When these bacteria are disrupted, other opportunistic bacteria and yeast can take up residence in your intestines. Supposedly, if you take your intestines and scrape all of the bacteria out of them and place it on a scale, it would weigh between two to five pounds. (I don’t know how they know this, and am not sure I want to.)
Anything that can disrupt your usual intestinal bacteria can cause intestinal dysbiosis. Antibiotics are a frequent trigger since they kill off some healthy intestinal bacteria along with whatever other bug they are supposed to kill. Symptoms vary but often include abdominal bloating and discomfort (particularly with eating); constipation and/or diarrhea; excessive flatulence, and worsening of symptoms with ingestion of alcohol and/or a large amount of carbohydrates, especially simple sugars. Dysbiosis can cause a number of symptoms outside of the gastrointestinal tract as well: decreased mental clarity, fatigue, malaise, generalized muscle and joint aches, and food intolerances. Sometimes the only symptoms may be those outside of the gastrointestinal tract.
What can be done about this common but frequently unrecognized condition? Just as the poor gentleman with auto-brewery syndrome was treated, a two-part approach exists. One of the most critical components is following a carbohydrate restricted diet. Utilizing probiotics (capsules containing normal, healthy bacteria that should be in your gut) and antifungal, antibacterial, and/or antiparasitic medications or supplements as appropriate constitutes the other part. Sometimes, if symptoms are mild, they may respond to the addition of an over-the-counter probiotic to a nutrient-dense, whole food diet. If you ever have to take an antibiotic, it’s reasonable to take a probiotic capsule at least 2 hours apart from any antibiotic dose (so the antibiotic doesn’t kill the probiotic on the way down) and to continue the probiotic for a week or two after finishing the last dose of antibiotic to help maintain your healthy bacteria.
If you think you may have intestinal dysbiosis, I recommend seeing a functional medicine practitioner. You can find one here. If you have any blood in your stools or severe abdominal pain, you should see your doctor right away.
This article in no way constitutes medical advice and if you are having physical symptoms, these should be addressed by an appropriate health care practitioner. Live long and live well.
©2013 by Luc Readinger, MD
Beer Belly: Man Becomes Drunk When Stomach Turns Into a Brewery
A Case Study of Gut Fermentation (Auto-Brewery) with Saccharomyces cerevisiae as the Causative Organism
When you work in an industry, you become privy to its dirty little secrets. What I want to share with you are reviews of several articles I’ve read over the course of my career that have formed my view of medical literature, from editorials to randomized controlled trials. Though you may come to conclude that I'm jaded, I would argue that by treating the literature with skepticism, I am able to better serve my patients.
This editorial appeared in Journal of the American Medical Association in 1997.
In the late 80’s, Synthroid, the dominant drug for thyroid hormone replacement, contracted Betty Dong, PharmD at UCSF to do research that would determine bioequivalence amongst different thyroid hormone replacement medications. This research had not been done previously. Bioequivalence is the property whereby two drugs with the same active ingredient produce the same physiological effect. Hypothyroidism is a condition where the body does not produce enough thyroid hormone to properly regulate the body’s metabolism leading to symptoms such as fatigue, feeling cold, and others. Synthroid, the first synthetic thyroid replacement medication, had been the favorite medication for treating hypothyroidism since it came on the market in 1958. Prior to this, animal extracts were used. The makers of Synthroid wanted the study done to prove the superiority of their product because the state of Massachusetts was considering adding a competitor’s formulation to the state formulary.
Betty Dong had written favorably on Synthroid in the past. She signed a contract with Synthroid’s manufacturers to conduct the new research comparing the bioequivalence of multiple thyroid replacement preparations. The contract specified all of the research parameters and statistical methods to be used. The company maintained a close eye on her work, visiting her several times a year to oversee the research. Except for a few minor adjustments, the work proceeded as anticipated. And then the results came in. All of the thyroid preparations being tested turned out to be equivalent to one another. It was calculated that using generic preparations instead of Synthroid would save $356 million per year.
Synthroid’s manufacturers immediately began a campaign to discredit the research and Dong. They met with the university. Lawyers got involved. Dong stood by her results and the statistical analysis (done using the exact methods as agreed upon in the contract.) The study and Dong’s conclusions were sound. The university supported her. This was important information that the medical community would benefit from knowing as no other study had rigorously tested the bioequivalence of various thyroid replacement preparations before. When Dong and her team went to publish, they were blocked by the makers of Synthroid. A clause in the contract required Synthroid’s written permission to publish the study and its results. Synthroid’s executives threatened to sue Dong and the other researchers if they published the paper. They withdrew the article from publication at the last minute.
Synthroid then published the data using different statistical methods to show that it was superior to other preparations. They did this with their own physician listed as the lead author in a journal of which he was the editor. Credit was not given to Dong or any of her colleagues who worked on the study.
Eventually Dong’s original research paper was published with the consent of Synthroid after they decided the negative press they were receiving was more egregious to them than having the actual study published.
The editorial gives a behind-the-scenes look at what can happen in the world of medical research. The conflict of interest between academic researchers and the commercial interests that fund them highlights the struggle to control the dissemination of medical knowledge. In this case, a commercial interest attempted to suppress information beneficial to the medical community (and public) to protect its investments and profit margins.
Realizing that behind every study lies interests beyond those of medical knowledge helped me to read the medical literature more critically. While you can’t read the backstory of every paper published, you can learn to read between the lines. I now look to see who funded a study before I even consider reading it. Protecting patients from commercial interests that go against their own is part of my duty to them as a physician.
I encourage you to read the entire editorial originally published in JAMA that can be found here. There is also a write up of the full story from the Wall Street Journal that can be found here. Both of these recount the story in more detail. Remember Thyroid Storm whenever you read about a new medical study reported in the press.
©2013 by Luc Readinger, MD